Left-Sided Portal Hypertension: A Sinister Entity

Fernandes, Alexandra; Almeida, Nuno; Ferreira, Ana; Casela, Adriano; Gomes, Dário; Portela, Francisco; Camacho, Ernestina; Sofia, Carlos

doi:10.1016/j.jpge.2015.09.006

Cited by 33 publications

(40 citation statements)

References 24 publications

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“…The splenic vein courses directly over the surface of the pancreas, and extension of inflammation from the pancreas to the perivascular tissues could potentiate splenic vein thrombosis . Pancreatitis‐induced splenic vein thrombosis is the primary cause of sinistral portal hypertension in people, which can lead to acquired gastric and esophageal varices . Pancreatitis has been documented as a comorbidity in dogs with splenic vein thrombosis, but the development of associated sinistral portal hypertension is not reported …”

Section: Discussionmentioning

confidence: 99%

Presumptive non‐cirrhotic bleeding esophageal varices in a dog

Myers

Scrivani

Simpson

2018

Veterinary Internal Medicne

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An 8‐year‐old male American Staffordshire terrier was admitted for evaluation of chronic episodes of ptyalism and hematemesis after exercise. Abnormalities were not detected on routine clinicopathological tests, thoracic radiography, and abdominal ultrasonography. Endoscopic examination revealed a labyrinthine network of severely distended, hemorrhagic esophageal blood vessels. Computed tomography angiography demonstrated a network of para‐esophageal vessels that communicated with the celiac artery caudally and the brachiocephalic trunk cranially, consistent with a diagnosis of non‐cirrhotic esophageal varices. This is a report of exercise, ptyalism, and hematemesis secondary to presumptive, non‐cirrhotic, bleeding esophageal varices in a dog.

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Section: Discussionmentioning

confidence: 99%

Presumptive non‐cirrhotic bleeding esophageal varices in a dog

Myers

Scrivani

Simpson

2018

Veterinary Internal Medicne

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“…hypertension. 3 Sinistral portal hypertension is considered a misnomer given the normal pressure in the portal vein in these patients. 3 To avoid misunderstanding, in this manuscript authors will use the term regional SV hypertension to refer to this condition.…”

Section: Introductionmentioning

confidence: 99%

CT angiography identifies collaterals in dogs with splenic vein obstruction and presumed regional splenic vein hypertension

Specchi¹,

Bertolini

2020

Vet Radiology Ultrasound

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Occlusion of the splenic vein, without occlusion of the portal vein, can lead to a localized, regional splenic hypertension, referred as sinistral or left-sided portal hypertension in the human radiology literature. In people, may cause gastrointestinal hemorrhages from the esophageal and gastric varices and the primary pathology usually includes pancreatitis and pancreatic neoplasms. The final diagnosis of localized splenic hypertension necessitates accompanying normal liver functions and a patent extrahepatic portal vein. Following obstruction, the resultant elevated splenic bed venous pressure causes formation of collateral routes, the extent of which depends upon the level and degree of obstruction. In this retrospective descriptive study, authors assessed the collateral pathways in dogs with isolated splenic vein occlusion and possible regional splenic vein hypertension. Out of the 46 patients initially recruited, 25 were excluded due to the presence of concomitant portal thrombosis and direct/indirect CT signs of portal hypertension. The remaining 21 dogs had clinicopathological tests suggesting normal liver function. The causes of obstruction identified included splenic pedicle torsion, tumoral splenic vein invasion, and splenic vein thrombosis. Four of 21 dogs with isolated splenic vein obstruction showed collateral pathways through the left gastroepiploic vein (4/4), left gastric vein (2/4), and splenogonadal vein (1/4). The diagnosis of isolated, regional splenic hypertension should be based on clinical, biochemical, and radiological evaluation. Computed tomography is an excellent tool to assess the collateral patterns and to determine the underlying cause.

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“…Left-sided portal hypertension (LSPH) is a rare clinical syndrome that can lead to bleeding from isolated gastric varices with normal liver function [6]. The most common causes of LSPH include chronic pancreatitis, pancreatic pseudocysts, and various pancreatic tumors [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

Yu¹,

Li²,

Gong

et al. 2020

BMC Gastroenterol

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Background: Left-sided portal hypertension (LSPH) is an extremely rare clinical syndrome, and it is the only form of curable portal hypertension. It is primarily caused by pancreatic disease, and is associated with complications that cause spleen vein compression. Specific symptoms are often lacking, rendering it difficult to diagnose. Splenectomy is the main treatment for cases complicated by variceal bleeding, and the effects of treatment primarily depend on the condition of the primary disease. Case presentation: The patient was a 29-year-old woman who was admitted to the hospital for repeated hematemesis and black stool. She had been misdiagnosed with pancreatic cancer 7 years prior. Combined imaging and endoscopic examination indicated varicose gastric fundus veins, a pancreatic mass, and enlarged peripancreatic lymph nodes. Laboratory investigations revealed reduced erythrocyte, platelet, and leukocyte counts, the interferon gamma release assay was positive, and liver function was normal. Abdominal exploration, splenectomy, varicose vein dissection, and lesion resection were performed via laparotomy. Postoperative biopsy analysis confirmed the diagnosis of lymph node tuberculosis. Based on the above-described factors, LSPH caused by peripancreatic lymph node tuberculosis was a diagnosed. Conclusions: Herein we describe the first reported case of LSPH caused by peripancreatic lymph node tuberculosis. When left portal hypertension occurs simultaneously, peripancreatic lymph node tuberculosis is often misdiagnosed as pancreatic cancer. Further studies are necessary to develop a more favorable diagnostic method for pancreas masses and more advantageous therapy for LSPH, especially in cases caused by mechanical compression.

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Left-Sided Portal Hypertension: A Sinister Entity

Cited by 33 publications

References 24 publications

Presumptive non‐cirrhotic bleeding esophageal varices in a dog

Presumptive non‐cirrhotic bleeding esophageal varices in a dog

CT angiography identifies collaterals in dogs with splenic vein obstruction and presumed regional splenic vein hypertension

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

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